If anyone is searching for some sign, any sign of consistency in this upside-down, underwater economy, then maybe there's some to be found in the annual list of Berks County's top employers.

Yes, some of these employers cut jobs last year. Others added to their employment rolls. Yet there was markedly little change in the components of the list.

But who knows what this year may bring?

One troubling omen has materialized in Manpower Inc.'s employment outlook survey for the first quarter.

The Reading area was in a sixth-place tie for the weakest employment outlook in the nation, with a net outlook of minus 6 percent. That is to say, 16 percent of employers surveyed in Berks County planned to reduce their work force, while only 10 percent planned to hire. Most of the remainder expected to maintain levels.

But Gretchen Strouphar, branch manager of Manpower's Spring Township office, downplayed the gloominess of the report.

"One of positive things we're taking from it is, we are seeing some of our customers very, very active," Strouphar said. "People are just proceeding with caution. A lot of ... what we see is a holding pattern."

Ellen T. Horan, president and chief executive of the Greater Reading Chamber of Commerce & Industry, agreed, saying that employers are being cautious and hunkering down.

She hesitated to call an end to the recession - "I keep hearing about the magical third quarter, but I haven't heard any strong cases for why" - but said hiring may come around.

"I think that ... companies are running though their inventory, but you can only be so cautious so long," Horan said. "You can only hold out so long from purchasing or from hiring."

Once again the area's top employer, Reading Hospital added a remarkable number of jobs, almost 500, in 2008, which its president, Scott R. Wolfe, said was mostly attributable to the growth of its medical group, a network of formerly private medical practices. But Wolfe said he expects its employment trend of year-over-year gains to plateau over the next year and a half.

That is in large part due to the economy: As more individuals find themselves without affordable health care, demand for services will decrease.

"The less volume comes in here, the less of a revenue stream is available for costs already sunk in staff needed to run an operation 24/7," Wolfe said.

Ultimately, though, demand is expected to increase because of patients deferring care, which will lead to pent-up illnesses and patients more urgently seeking care at later stages than they otherwise would have, he said.

"We have to make capacity decisions relative to this," Wolfe said, "because ultimately it will come as this patient population continues to age."

Rising health care costs also piqued the curiosity of Edward J. McCann Jr., Berks County's director of work-force development, who observed that roughly half of the top employers list consists of public or nonprofit entities.

"You wonder how long the nonpublic sector can support the public sector, because generally speaking, the schools and the city, county and state governments have more secure pension arrangements and in many cases much lower copays on health coverage than the other people you tend to think of as supporting the economy," he said.

In the meantime, McCann said he wouldn't be surprised to see some job shakeout in the retail sector and some compression of the area's auto dealerships, following national trends. He said he is hopeful that the acquisitions of Sovereign Bancorp by Banco Santander and of Wachovia by Wells Fargo & Co., both banks that are very active in Berks County, will not result in high job losses.

"There shouldn't be much of an impact because none of the acquiring banks is in this area," he said. "But you always consider the fact that there could be back-office consolidation."

What else is on the horizon? The area's czar of business attraction, Jon C. Scott, president and chief executive of Berks Economic Partnership, said the economic-development organization is communicating with about a half-dozen prospects that could decide to locate and hire in Berks County.

"No doubt this is going to be a very difficult year for almost all businesses," Scott said. "But we still have a lot to offer."